Ashley Ramirez

Teen Receives Life-Saving Lung Transplant

By Abby Sinnott

At just 19 years old, Ashley Ramirez has already experienced enough for an entire lifetime. In January 2005, Ramirez underwent a bilateral, or double lung transplant at UCSF Medical Center. But it wasn't until she was in critical condition — when doctors said she probably had only another 24 hours to live — that lungs for Ramirez were finally found.

Lung transplants are given to people for irreversible lung failure. Lung failure occurs when the lungs are damaged and unable to transfer oxygen and carbon dioxide to and away from cells. Conditions such as emphysema, cystic fibrosis and pulmonary fibrosis can cause lung failure.

At 14 years old, Ramirez was diagnosed with thyroid cancer and although her thyroid was removed surgically, the cancer had already spread to her lungs. Ramirez received high doses of radioactive treatment, which, despite treating some of her cancer, caused scar tissue to build up in her lungs.

As a result, Ramirez experienced increasing difficulty breathing and was put on oxygen for two years while she attended high school in Phoenix, AZ. While other teens worried about dating and school dances, Ramirez was trying to "feel normal" with an oxygen tank attached to her. On her 18th birthday, a severe case of pneumonia landed her in the hospital where she was put on life support.

"It was really scary for me," remembers Ramirez. "Lung transplant had been suggested to us as an option, but no one would accept me because I had had cancer. They thought it was a waste to give someone like me new lungs."

Generally, in order to qualify for a lung transplant, a person must be completely free of other life-threatening illnesses, such as cancer. Although Ramirez's tumor count was down, Ramirez wasn't completely cancer free and doctors feared that any lingering cancer would spread to her new lungs.

But Ramirez's doctor in Phoenix encouraged her to continue searching for a medical center that would help find her lungs from a donor. Ramirez's doctor called Dr. Orlo Clark, an expert in endocrine surgery, thyroid cancer and other endocrine malignancies at UCSF, who had removed some of Ramirez's recurrent cervical lymph nodes after her initial thyroid surgery in Arizona.

Clark immediately offered his help and called the lung transplant team at UCSF to begin the search for Ashley's new pair of lungs. Clark assured the transplant team that Ramirez's kind of cancer was slow moving and that once she got her lung transplant, she could receive one more radioactive iodine treatment, which would lead her into cancer remission.

Based on a number of factors, Clark advised the UCSF transplant registry and team, as well as Ramirez's medical insurance company about the low risk a potential lung transplant would have for causing Ramirez's thyroid cancer to become more aggressive. Moreover, if Ramirez had any residual thyroid cancer, as suggested by blood tests, it would primarily be in her lungs, which would be removed at the time of transplantation.

"Luckily, upon seeing the appropriate information, the transplant registry and insurance company both agreed that a lung transplant was the best medical choice for Ashley," says Clark.

Dedicated to providing the most comprehensive medical and surgical care found anywhere, the lung transplant team at UCSF has performed close to 200 transplants since the program started in 1991, with an average one-year survival rate of 80 percent compared to a national average one-year survival rate of 70 percent.

Ramirez and her mother, Wendy Bingham, returned to UCSF, where doctors told Ramirez that she had only about 10 percent lung function. Clark surgically removed more of Ramirez's lymph nodes to ensure any remaining cancer would not spread to her new lungs.

Ramirez was discharged after the operation but was shortly back in the Intensive Care Unit (ICU) because of another case of severe pneumonia with pulmonary failure. As a result, she could not fly back home to Phoenix, and once stabilized, moved into UCSF's Koret Family House to wait for lungs to be found.

Because of the scarcity of available lungs, potential organ recipients can wait months to years until compatible organs are found. In 2005, approximately 3,500 people in the U.S. were waiting for a lung transplant, yet only 1,000 of them received one.

Like many patients waiting for organs, Ramirez's health was steadily declining. Three months had passed and on Jan. 2, 2005, Ramirez couldn't stop coughing and was unable to breathe, no matter how much oxygen her mother gave her. "I didn't want to go to the hospital, because I thought that if I did, they'd never bring me back," remembers Ramirez.

But she had no choice and was admitted to UCSF where Dr. Charles Hoopes, director of heart and lung transplants at UCSF, took one look at Ramirez and knew that if she didnt undergo a transplant within the next 24 hours, she wouldnt make it.

"It was really scary for me because everyone kept saying I wouldn't make it," remembers Ramirez. "But I was determined to prove them wrong and said, 'Okay, just watch me.'"

Hoopes was determined and called all over the country until he found Ramirez a pair of lungs from a cadaver donor. She underwent a double lung transplant that day, which saved her life. And although the surgery was a success, Ramirez says the road to recovery was a long one. One of the hardest parts, she remembers, was learning to breathe again and "growing into" her new set of lungs.

But eventually, Ramirez got used to her new lungs and her health improved by leaps and bounds. Last spring, she even participated in San Francisco's Bay To Breaker's race with Dr. Steven Hays, Ramirez's pulmonologist at UCSF, who specializes in the care of lung transplant patients.

Now, one year after transplant, Ramirez is a freshman at Mesa Community College in Phoenix, where she is taking West African dance classes and considering a major in biotechnology. She's doing so well that her monthly check-ups at UCSF have been extended to every three months something Ramirez considers "bittersweet."
Recently, after undergoing a blood test and full body scan, she was declared cancer free.

"My doctors are the best in the world," says Ramirez. "When they told me I only have to come every three months now, I started to cry. It's great that Im doing well, but really hard that I won't be able to see them as much."

Ramirez plans to keep in touch and will return to San Francisco in May to participate in the Bay to Breakers race again with the UCSF lung transplant team.

"I hope my story will help and inspire other people because I had cancer and then was able to get a transplant," says Ramirez. "I'm so thankful to the doctors at UCSF for giving me the chance when no one else would, and for taking that risk which kept me alive."